Public and Private Sector Reimbursement

Fair and Rational Medicare Payment for Molecular Diagnostic Tests

Policy Position

In support of Personalized Medicine for the benefit of patients…

Whereas fair and equitable payment for molecular based tests has a direct impact on patient access to this important source of personalized medicine information and whereas undervaluation of such tests has a detrimental effect on access, the PMC supports the following position:

Molecular tests that involve professional services should be placed on the Physician Fee schedule and not on the Clinical Laboratory Fee schedule, in accordance with both the Social Security Act and CMS regulations. The RUC process provides relative values for both the technical and professional components of the test process and is a true reflection of the costs incurred.

References

Soc Sec Act 42C.F.R. 410.20; 42 U.S.C 1395x(q),(r);
42U.S.C 1395w-4(a)(1) CMS Regulation., Pt 3, Ch5 5114.1

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